CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1530 4130.500000 152800.7500 36.9933
Subtotal (Total Children Is Unduplicated) 1530 4130.500000 152800.7500 36.9933
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 19.500000 1462.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 15.000000 832.5000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 82 108.500000 6021.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 108 141.000000 10575.0000 75.0000
Subtotal (Total Children Is Unduplicated) 182 284.000000 18891.7500 66.5202
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 62.000000 3100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 17 62.000000 3100.0000 50.0000
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Total 4476.500000 174792.5000 39.0467
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Number of Children (Unduplicated) With at Least One Service 1533
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Center 01
Flag Claims Units Chgs Paid
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R 3 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1580 1134.750000 46444.2500 0.0000
P 4354 3339.250000 128255.7500 128246.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5937 4476.500000 174792.5000 128246.5000